Hospital Kuala Lumpur (HKL) today gave the green light for jailed ex-deputy premier Anwar Ibrahim's personal doctors to conduct an examination on him following his deteriorating health condition .

"Dr Halili Rahmat and Dr Husin Awang have been permitted to examine Anwar next Monday together with doctors from HKL," Anwar's lawyer Sankara Nair told malaysiakini this afternoon.

Anwar, who has been warded at HKL since Tuesday, was informed of the approval this morning and conveyed the decision to Nair during a visit. Anwar had requested for the services of his personal physicians nearly a month ago, said Nair.

On Anwar's current condition, the lawyer said his pain was now under control as it was being treated with medication.

An MRI scan on Anwar following his Tuesday admission revealed that he is suffering from spinal stenosis - a narrowing of the spaces in the spine resulting in pressure on the spinal cord and nerve roots causing excruciating pain.

This is believed to have worsened his slipped disc condition and in turn has affected his kidney and neurological functions.

Since 2001, Anwar has repeatedly requested to undergo endoscopic surgery for his spinal problem at the AlphaKlinik in Munich, Germany. The government has refused to grant permission for the overseas trip.

'Minimally invasive'

On Wednesday, Health Minister Dr Chua Soi Lek reiterated the government's stand not to allow Anwar abroad for surgery, even as his health took a turn for the worse.

Rejecting the request, Chua said all forms of treatment required by Anwar were available in Malaysia adding that the risks arising from a local surgery were minimal and the operation had a 99 percent success rate.

Extrapolating on Anwar's insistence on surgery at the AlphaKlinik, Nair told malaysiakini there were key differences between endoscopic microsurgery performed there as opposed to the conventional 'open surgery' available locally.

He noted that Anwar's neurosurgeon Halili has recommended that the endoscopic microsurgery best be done in a hospital with a dedicated spinal centre. Similar recommendations have also been made by neurosurgeons from Dublin and Australia.

Anwar's doctor of choice, Dr Thomas Hoogland at AlphaKlinik, had also opined that the endoscopic microsurgery is to be preferred over conventional open surgery.

"In short, the main benefits of microsurgery is that it is minimally invasive," Nair said.

He said Anwar had also been advised that he should not restrict himself only to the narrow issue of preference between two spine surgery techniques, but rather also examine other issues fundamental in making a calculated medical decision.

"We have been advised that the focus should therefore extend and include criteria such as inter alia, a practitioner's expertise, experience, eminence and proven ability besides the number of surgeries he has performed," he explained.

In terms of facilities, Anwar and his family were therefore advised that considerations such as the volume of spine surgeries performed at AlphaKlinik and its 'spine only' dedicated nature were criteria that mandated serious consideration.

'Highly acclaimed'

Nair said given this guideline, Anwar's family 'can't help' but see that HKL has only what are essentially 'general' neuro-orthopaedic surgeons who routinely perform an assortment of surgeries on the human anatomy including the spine.

"Hence, we are advised that going by accepted norms, they are not dedicated or exclusively 'spine only' surgeons.

"And in terms of facilities, again, with all due respect to HKL, we wish to state that our statistics indicate an average of only about four spine surgeries a month and that the facility is not a dedicated spine centre," he noted.

Nair claimed that the AlphaKlinik on the other hand, was highly acclaimed as a dedicated 'spine only' centre in the global medical scene with Hoogland having successfully performed over 8,000 minimal invasive-type spine micro-surgeries to date.

This compared to HKL's panel of doctors who have performed around 500 similar surgeries over the past 10 years. On an average, the AlphaKlinik also performs 15 times more spine surgeries in a month compared with four surgeries per month at HKL.

Nair, however, reiterated that Anwar and his family holds HKL's panel of surgeons in high esteem and had no desire to undermine their professionalism inasmuch as they had to make a calculated medical decision.

The lawyer also stressed that a person was legally entitled to choose a form of medical treatment he or she preferred as part of fundamental human rights principles, despite Malaysian Prison Department rules which remain vague on the rights of a prisoner for medical treatment of his choice.

'Very rude'

Meanwhile, HKL director Dr Jalal Halil Khalil snubbed a delegation from the Human Rights Commission (Suhakam) today who wanted a briefing on Anwar's condition.

Suhakam commissioner Prof Hamdan Adnan told malaysiakini that he was initially informed that the director had gone on leave today and could not meet them.

"However, we found out that he was at the hospital today and had refused to meet us despite making us wait for 45 minutes ... he has lied and been very rude," the furious commissioner said. The other commissioner present was Dr Mohammad Hirman Ritom Abdullah.

Hamdan said Suhakam was hoping to meet with the director to obtain accurate medical information from the hospital on Anwar's health status.

Bar Council vice-chairperson Yeo Yang Poh, meanwhile, was quoted in the Nanyang Siang Pau Chinese daily today as supporting Anwar's insistence for overseas surgery.

He said despite the prisons department regulation being vague, the government should allow the ex-deputy premier to receive the non-invasive surgery on humanitarian grounds.

Anwar is currently serving a nine-year jail sentence for sodomy and is awaiting a Federal Court decision next Thursday on his final appeal against the conviction. He has already completed a six-year sentence for corruption.

He claims the charges against him were trumped up but the government has denied it.